Daycare may double TV time for young children, study finds

In a new study, the amount of television viewed by many young children in child care settings doubles the previous estimates of early childhood screen time, with those in home-based settings watching significantly more on average than those in center-based daycares. This study is the first to examine screen time in child care settings in more than 20 years. The study looked at television use in 168 child care programs in four states, and was guided by lead researcher Dimitri A. Christakis, MD, MPH, director of the Center for Child Health, Behavior and Development at Seattle Children's Research Institute and professor of pediatrics at the University of Washington School of Medicine. "Preschool-Aged Children's Television Viewing in Child Care Settings" is published in the December 2009 issue of Pediatrics, appearing online November 23, 2009.

Previous estimates of screen time for babies and pre-school children relied on parental reports of viewing in the home, yet the majority of pre-schoolers are now commonly cared for by someone other than a parent, away from home in a child care setting. Prior studies have estimated that preschool children watch 2-3 hours of TV per day at home. According to the researchers, previous data on screen time in child care settings are more than 20 years old and don't accurately reflect today's cultural factors affecting media use among children.

The study found that among preschool-aged children, those in home-based daycares watched TV for 2.4 hours per day on average, compared to 0.4 hours in center-based settings. Some home-based programs were closer to the center-based programs in amount of time they used television, particularly those programs in which the staff had college degrees. With the exception of infants, children in home-based child care programs were exposed to significantly more television on an average day than children in center-based programs (infants: 0.2 vs 0 hours; toddlers: 1.6 vs 0.1 hours; preschool-aged children: 2.4 vs 0.4 hours). The greatest increase in screen time occurred in the preschool group, in home-based child care settings.

"It's alarming to find that so many children in the United States are watching essentially twice as much television as we previously thought," said Christakis. "Research continues to link excessive preschool screen time with language delay, obesity, attentional problems and even aggression depending upon content. At the same time, studies show that high quality preschool can be beneficial to children's development. Unfortunately, for many children, the potential benefits of preschool may be being displaced by passive TV viewing. I suspect many parents are unaware of the frequency and extent of TV viewing in day care settings. Hopefully, these findings will serve as a wake up call for them."

The study looked at television use in 168 child care programs located in Michigan, Florida, Washington and Massachusetts, 94 of which were home-based programs and 74 were center-based. The study assessed frequency and quantity of television viewing for infants, toddlers and pre-school aged children. Participants were asked if they used TVs, videos or DVDs in their classrooms. Those who responded yes were asked for which age groups television was used, and for approximately how many hours each week in each age group.

Data was collected about the child care program including hours of operation, number of staff members, number of children cared for, whether after-school care was provided onsite for school-aged children, and the educational level of child care providers.

"I think most parents expect their child's preschool environment to provide opportunities for cognitive stimulation, social interaction and physical activity. Television is a poor substitute for all of these," said Christakis. "We are increasingly technologizing childhood, which may prove harmful to the next generation of adults. Parents and health care providers should know how many total hours of screen time and what programs constitute children's media diet, just as they should know how many calories and what foods they're ingesting per day."

Center-based child care programs were found to provide an average of 1.84 fewer hours of screen time each day, nearly two hours less than home-based daycares. The impact of home-based versus center-based child care programs differed somewhat depending on educational levels for staff members; having a two- or four-year college degree was associated with 1.41 fewer hours of television per day in home-based programs, but no impact of staff education on television use was observed in center-based programs.

The American Academy of Pediatrics' Committee on Public Education (Pediatrics, 2001) specifically recommends against screen time for children under two years of age, urging more interactive play in its place.

Tips and resources for parents, caregivers and day care providers include the following recommendations:

For babies:

Avoid TV for children under age two. Choose activities that promote language development and brain growth such as talking, playing, reading, singing and enjoying music.

For children over age two:

If you allow TV time, choose age-appropriate programs. Involve parents and older children in setting guidelines for what to watch. Use guides and ratings to help, but beware of unproven claims that programs or DVDs are educational. Even cartoons produced for children can be violent or over stimulating. Make sure all programs or DVDs used at home and also in daycare are appropriate.

Limit total TV time to no more than two hours per day. Less is better. Be sure to add up TV time at home plus TV time in daycare.

For parents: talk to daycare providers about your concerns. Find out what children under their care will watch, when and how much. Speak up and set limits. Ask your child what they are watching in daycare, just as you would ask what they eat and what they do.

For daycare providers: remember that screen time is not proven to provide any benefits to children and may in fact cause harm if overused. Television replaces more positive activities like interactive play, singing, reading and talking. Choose to use TV sparingly and deliberately. Talk to parents about how television is used in the daycare setting, and respect their concerns and wishes.

Keep the TV off during meals.

Set "media-free" days and plan other fun things to do.

Avoid using TV as a reward.

Turn off the TV when a chosen program is over. Don't leave the TV on as background filler or while engaging in other activities. When no one is actively watching, turn the TV off.

Watch TV actively with children. Talk about what you see and engage with children about the content.

Christakis' research partner for the study was Michelle M. Garrison, PhD, also of Seattle Children's Research Institute.

Christakis is co-author of a related resource book for parents, The Elephant in the Living Room: Make Television Work for Your Kids. His growing body of research has included studies of baby DVD products, interactive play and influence on language acquisition, screen violence and aggressive behavior in young children, screen time and attentional disorders, and screen time and language acquisition.

About Seattle Children's Research Institute

At the forefront of pediatric medical research, Seattle Children's Research Institute is setting new standards in pediatric care and finding new cures for childhood diseases. Internationally recognized scientists and physicians at the Research Institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention and bioethics. With Seattle Children's Hospital and Seattle Children's Hospital Foundation, the Research Institute brings together the best minds in pediatric research to provide patients with the best care possible. Children's serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine, which consistently ranks as one of the best pediatric departments in the country. For more information visit http://www.seattlechildrens.org/research.

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